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Influenza

Introduction

Influenza is one of the most common infectious disease that is caused by the influenza virus (van Beek et al., 2017). It impacts the respiratory system of an individual and brings up symptoms such as cough, congestion, fever, and chills. Influenza infection is caused by four strains of influenza virus which are influenza virus A, B, C and D. Influenza is a very common disease and it highly impacts the people living in temperate climates and tropics climates. Outbreaks of influenza are very common during winter months in temperate climate but they occur more commonly in tropical climate throughout the year.

According to the world health organization estimates influenza epidemics annually impact 3-5 million people worldwide which leads to 250,000-500,000 deaths. Australia is a country that has high epidemiology of influenza. In 2019, 100,000 people were tested for influenza among which 1108 were diagnosed positive. The number of cases diagnosed in 2017 was 1021 which indicates an increasing prevalence of influenza in Australia. The purpose of the paper is to discuss the clinical issue of influenza infection by focusing on its pathogenesis, etiology, diagnostic process, clinical manifestations, and treatment options. The scope of the paper is focused on influenza infection among Australian people because they are highly impacted by the virus and the cases increase every year.

Etiology and Pathogenesis

According to Ip et al., (2017), Influenza is one of the most common communicable disease that affects the respiratory system of an individual. The virus transmits through respiratory droplets that are expelled from the respiratory system during sneezing, coughing and talking. Moreover, it can be spread by touching objects that have virus droplets over him. The disease is highly prevalent in tropical and temperate areas of the world. Moreover, it is very prevalent in Australia and it bring up an annual influenza outbreak there. There are four types of influenza viruses which are influenza viruses A, B, C, and D (Bi et al., 2017). The influenza virus type A and B can lead to annual human infection during the epidemic. The influenza virus type A is characterized by H and N types which are known as H1N1 and H3N2. The influenza virus type B is classified into several strains and lineages. The recent influenza epidemics in Australia were a reason of human influenza virus B transmission (Bi et al., 2017).

Factors such as age, living conditions, weak immune system, and use of aspirin under the age of 19 years, obesity and pregnancy are the major risk factors for influenza (Iuliano et al., 2018). Seasonal influenza in Australia targets adults over the age of 65 years and children below the age of 12 years most commonly (Iuliano et al., 2018). In addition to this, people who have chronic conditions such as cancer, COPD, diabetes or other immune-suppressed diseases are also at the risk of the disease. The virus is transmitted through physical contact with the respiratory droplets that comes from infected individuals. After transmission the influenza virus replicates in the epithelial cell lining of the lower and upper respiratory tracts. Pathophysiological studies have revealed that the bronchioles and trachea of patients suffering from influenza become red and inflamed (Moa et al., 2020). It also bring up purulent discharge, desquamation and destruction of the pseudostratified epithelium of the trachea.

Influenza is an acute disease that is linked with the upper respiratory tract. Progression of the disease brings up severe inflammation in the trachea and bracteoles in the respiratory tract (Moa et al., 2020). Clinical manifestations of the disease often persist for almost seven to ten days. The signs such as body aches, cough, and high fever are responses to viral infections and interferon reactions with those viruses. Severe complications of the disease can be seen after 48 hours of infection. The virus replicates and divides in the lower and upper respiratory passages of the respiratory tract beginning from inoculation to 48 hours of the infection which is called as peaking on average. Neuraminidase and hemagglutinin are proteins that are expressed on the surface of the influenza virus A (Nichols et al., 2019). These proteins are key targets of the neutralizing antibodies. The hemagglutinin adhere to the epithelial cells which lead to progression of the disease. Moreover, the neuraminidase cleave the viral bond and help it spread.

Lower respiratory complications such as superinfection with bacteria, exacerbation of underlying lung disease and influenza pneumonia are the most common influenza complications. Influenza progression can also lead to chronic lung damage (Nichols et al., 2019). Proteins in the influenza virus can multiply progressively which can lead to damage to the lung epithelial cells. The damage can lead to fluid buildup and ultimately lung damage. Influenza is a serious public health concern. It can lead to severe mortality and morbidity in the immune-compromised population. It has been seen that people nowadays do not have a very strong immune system so the influenza infection can also lead to severe health issues and complications.

Clinical Manifestations

Flu and the common cold are common respiratory conditions that are spread by two different viruses (Van Wyk, 2016). People with common cold are more susceptible to runny or stuffy nose in comparison to people that have influenza (Van Wyk, 2016). Since both of these conditions have similar symptoms, the distinction between them can be difficult to determine. “However, flu is usually worse than the common cold as symptoms are more severe. The common cold is milder than flu. Colds do not usually lead to severe health complications such as influenza, respiratory infections or hospitalizations. Complications associated with flu are generally very severe as it can also bring up chronic lung damage.

Common signs and symptoms of influenza include muscle ache, headache, chills and sweats, fatigue and weakness, and nasal congestion. Influenza is also characterized by dry and persistent cough with fever that ranges over 100.4 F or 38 degrees Celsius (Qualls et al., 2017). Flu or influenza can spread very rapidly and it can lead to common and persistent symptoms for days. Since influenza is a respiratory infection so it brings up respiratory distress and sore throat. The upper respiratory tract infection can bring up persistent cough and ultimately nasal congestion. The symptoms are very similar to the common cold but influenza can bring up complications that common cold cannot (Qualls et al., 2017).

Diagnostic Process

Influenza or flu can be diagnosed by a number of processes. Primarily the physician looks for signs and symptoms of flu but then the patient can be asked for a flu test (Ye et al., 2020). Patients at the time of epidemics are often asked for diagnostic tests to prevent mortality and morbidity. A conclusive influenza diagnosis includes serological, immunological, and molecular examination for upper or lower respiratory tract specimens. It can be performed by techniques such as RT-PCR. Mild cases display abnormal changes in the respiratory tract but serious cases display strong signs of abnormal pneumonia changes. Influenza tests are very common in areas of epidemics.

The most common influenza diagnostic tests are called "rapid influenza diagnostic tests (RIDTs)” (Uyeki et al., 2019). RIDTs are designed to detect the components of the viral antigens that works to stimulate an immune response in lungs (Uyeki et al., 2019). Such tests can provide results in around 10-15 minutes of the process, but these tests are not as reliable because fast results often neglect sensitivity. Blood tests are generally not performed if a patient lives in an epidemic facing area. However, a blood test can be performed to check the prevalence of the disease in the community.

Treatment

Influenza is a viral infection so treatment is slightly complex. The influenza infection is very common and prevalent in Australia. Mild influenza in healthy individual does not require any antiviral treatment because the infection is self-limited. However some antiviral medication such as Zenamivir, peramivir, and Oseltamivir can be used to treat and manage Influenza in regions of epidemics (Demicheli et al., 2018). These drugs are neuraminidase inhibitors and they can be used to prevent infection from influenza strain A and B. some medicines are specific for influenza virus A and some medicines can be specific for influenza virus B. So, it is always important to investigate the virus and transmission of the infection. For example: the Amantadine and rimantadine are used against the influenza virus type A. These medicines are ineffective against influenza type B virus (Demicheli et al., 2018).

One of the most serious complications for medication therapy for a viral disease is the development of resistance against the medicine. The virus evolves very fast and this can induce mutations. These mutations can ultimately contribute to the development of resistance. The recent influenza epidemic in Australia characterized several patients that developed resistance against Amantadine and Zenamivir (Moss et al., 2016). In this case, the patients can be administered with Oseltamivir. It can be used for chemoprophylaxis in a vulnerable population. The medicines have several side effects such as skin irritation and neuropsychiatric events. This is the reason why people with mild infection are asked to avoid medicines.

Immunization or vaccination is one of the most effective strategies that can prevent an individual from a disease or illness. Scientists have developed several vaccines for certain disease. Diseases such as polio and influenza have vaccines to prevent and manage the influenza infection. The flu vaccines are present in the form of both trivalent and quadrivalent intramuscular injection (Oliwa & Marais, 2017). These injections are characterized as IIV3, IIV4, TIV, QIV or RIV4. These vaccines contain inactivated viral strains or live attenuated virus particles that enter the host body but cannot multiply (Oliwa & Marais, 2017). However, they develop antibodies and memory for the management of further infection. The flu vaccine in Australia is recommended during winters for all the individuals over 6 months of age. The patient must be observed for 10-15 minutes after immunization.

Conclusion

Influenza is a common but very serious disease that can bring severe mortality and morbidity. Influenza has a significant health burden over the globe but temperate and tropical countries are impacted by it very commonly. Australia is a country that has a significant healthcare burden for influenza and it has progressive rates of the infection. The findings of the article indicate that influenza is a respiratory infection and it can bring up severe inflammation in the upper respiratory tract. There are a total of four influenza virus strains which include influenza virus type A, B, C and D.

A and B influenza viruses cause human infection and are responsible for major influenza epidemics. Influenza and the common cold have similar symptoms but both of them distinguish in severity. Common cold is less severe than influenza because influenza has several health complications such as chronic lung damage. Diagnostic techniques such as RIDTs can be used to diagnose the infection. Medicine is not used for mild infection but they are recommended at the time of the epidemic. Vaccination must be provided to individuals over 6 months of age at the time of epidemic to prevent the condition.

Reference

Bi, Y., Tan, S., Yang, Y., Wong, G., Zhao, M., Zhang, Q., ... & Li, H. (2019). Clinical and immunological characteristics of human infections with H5N6 avian influenza virus. Clinical Infectious Diseases, 68(7), 1100-1109.

Demicheli, V., Jefferson, T., Ferroni, E., Rivetti, A., & Di Pietrantonj, C. (2018). Vaccines for preventing influenza in healthy adults. Cochrane Database of Systematic Reviews, (2).

Ip, D. K., Lau, L. L., Leung, N. H., Fang, V. J., Chan, K. H., Chu, D. K., ... & Cowling, B. J. (2017). Viral shedding and transmission potential of asymptomatic and paucisymptomatic influenza virus infections in the community. Clinical Infectious Diseases, 64(6), 736-742

Iuliano, A. D., Roguski, K. M., Chang, H. H., Muscatello, D. J., Palekar, R., Tempia, S., ... & Wu, P. (2018). Estimates of global seasonal influenza-associated respiratory mortality: a modelling study. The Lancet, 391(10127), 1285-1300.

Moa, A. M., Muscatello, D. J., Turner, R. M., & MacIntyre, C. R. (2020). Estimated hospitalisations attributable to seasonal and pandemic influenza in Australia: 2001-2013. PloS One, 15(4), e0230705.

Moss, R., McCaw, J. M., Cheng, A. C., Hurt, A. C., & McVernon, J. (2016). Reducing disease burden in an influenza pandemic by targeted delivery of neuraminidase inhibitors: mathematical models in the Australian context. BMC Infectious Diseases, 16(1), 552.

Nichols, J. E., Niles, J. A., Fleming, E. H., & Roberts, N. J. (2019). The role of cell surface expression of influenza virus neuraminidase in induction of human lymphocyte apoptosis. Virology, 534, 80-86

Oliwa, J. N., & Marais, B. J. (2017). Vaccines to prevent pneumonia in children–a developing country perspective. Paediatric Respiratory Reviews, 22, 23-30.

Qualls, N., Levitt, A., Kanade, N., Wright-Jegede, N., Dopson, S., Biggerstaff, M., & Levitt, A. (2017). Community mitigation guidelines to prevent pandemic influenza—United States, 2017. MMWR Recommendations and Reports, 66(1), 1.

Uyeki, T. M., Bernstein, H. H., Bradley, J. S., Englund, J. A., File Jr, T. M., Fry, A. M., ... & Ison, M. G. (2019). Clinical practice guidelines by the Infectious Diseases Society of America: 2018 update on diagnosis, treatment, chemoprophylaxis, and institutional outbreak management of seasonal influenza. Clinical Infectious Diseases, 68(6), e1-e47.

van Beek, J., Veenhoven, R. H., Bruin, J. P., Van Boxtel, R. A., de Lange, M. M., Meijer, A., ... & Luytjes, W. (2017). Influenza-like illness incidence is not reduced by influenza vaccination in a cohort of older adults, despite effectively reducing laboratory-confirmed influenza virus infections. The Journal of Infectious Diseases, 216(4), 415-424.

Van Wyk, H. (2016). The common cold and influenza. South African Pharmacist's Assistant, 16(1), 7-10.

Ye, F., Cui, M., Khasawneh, R. H., Shibata, R., Wu, J., Sharaan, M., & Zhang, D. Y. (2020). Molecular Virology. Molecular Genetic Pathology, 655

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